“Noah,” I call back, “I think we’re dealing with pulmonary edema from his position and compressed chest.”
There’s a moment of silence, then his voice comes as a formless echo in the darkness. “Can you see any way to improve his position?”
I study the way Derek is wedged into the narrowing passage. “No. He’s completely trapped until the rescue team can pull him out.”
“Holly,” Noah’s voice is calm but serious, “have you ever performed a thoracentesis before?”
A thoracentesis—a procedure to remove excess fluid from the space around the lungs. My mouth goes dry.
“Yes,” I answer honestly, “but never outside of a hospital.”
“Well, now’s your chance.”
I swallow hard, looking at Derek’s increasingly distressed face. His lips are taking on a bluish tinge despite the oxygen.
“I don’t know if I can do this here,” I admit, voice low. “The space, the lighting, the position—it’s all wrong.”
“This is exactly the high-speed experience you signed up for,” Noah reminds me, his voice steady and confident. “And I know you can do it. You’ve got the steadiest hands in the clinic.”
The compliment steadies me. I take a deep breath and reach for my kit, mentally reviewing the procedure. In a hospital, we’d use ultrasound guidance, sterile fields, proper positioning. Here, I have none of those things—just my training, my hands, and a man who will die without intervention.
“Derek,” I say, meeting his frightened eyes, “I need to remove some fluid from around your lungs to help you breathe. It’s going to be uncomfortable, but it should provide relief. Do you understand?”
He manages a small nod, eyes wide with fear but also desperate hope.
I prepare my supplies—a large-bore needle, syringe, antiseptic wipes. My hands move with practiced efficiency despite the awkward position and limited space.
“I’m going to need to access your chest,” I explain, carefully cutting away his shirt with trauma shears. “Try to stay as still as possible.”
His skin is clammy under my gloved fingers as I locate the proper intercostal space. I clean the area as thoroughly as I can considering I’m kneeling on dirt-caked rock, mentally mapping the anatomy beneath the surface. One wrong move could puncture a lung or damage the intercostal vessels.
“Deep breath in,” I instruct, then realize the irony of my words given his condition. “As deep as you can manage.”
I insert the needle with steady pressure, feeling the slight pop as it passes through the pleural space. When I pull back on the syringe, cloudy fluid fills the chamber—confirmation that my diagnosis was correct.
“Got it,” I report to Noah, carefully withdrawing the maximum amount of fluid the syringe can hold.
Derek’s breathing immediately eases, the desperate gasping replaced by still-labored but more effective respirations.
“Better?” I ask him.
He nods weakly. “Yeah... better...”
I prepare for a second aspiration, knowing I’ve only removed a fraction of the accumulated fluid. “I’m going to do this one more time, then we’ll get you out of here.”
As if on cue, a voice calls from further up the passage: “Dr. Chang? We’ve got a new extraction system ready to go. How’s the patient?”
“We’ve bought him a little more time,” I call back. “But we need to move quickly.”
I complete the second aspiration, giving Derek’s lungs enough relief that his oxygen saturation improves to acceptable levels. Then, I secure the oxygen mask more firmly and prepare him for extraction.
“They’re going to pull you out now,” I explain, checking that the new harness they’ve lowered is properly secured around his legs. “It’s going to hurt, but try to stay as relaxed as possible. I’ll be right here the whole time. Just hold on.”
Derek nods, expression a combination of fear and determination as he gives a pained whimper. “Okay.”
I back up as far as the narrow passage allows, giving the rescue team clearance to begin the extraction. Noah’s hand finds mine in the darkness, a brief squeeze of reassurance.
“Good work, Dr. Chang,” he murmurs.
